a strategic plan for the state of texas to meet nursing ... · a strategic plan for the state of...
TRANSCRIPT
A Strategic Plan for the State of Texas To Meet Nursing Workforce Needs of 2013
Developed by
In Collaboration with Texas Board of Nursing
Texas Higher Education Coordinating Board Texas Nurses Association
Texas Center for Nursing Workforce Studies Texas Hospital Association Texas Workforce System
AARPndash Texas Office State Representative Donna Howard
Office of the Governor
December 2008 Updated March 2009
Texas must strive for synergies partnerships
disruptions and innovation in order to meet the goal of producing sufficient initial RN licensure graduates
H
A Summary
The nation and Texas face a shortage of nurses predicted to worsen over the next twenty years as baby boomers age and the need for health care growsTexas schools of nursing like others across the nation face significant barriers to increasing capacity and output of graduates Nursing schools face the challenge of revising curricula and educational approaches to better match the realities of clinical practice in the 21st century including the need to continuously improve the quality and safety of nursing and health care delivery across the state
The purpose of this Strategic Plan to Address Nursing Education Capacity in Texas is to provide comprehensive strategies which address the complexity of nursing education capacity for the State of Texas and the need to increase the number of graduates to meet demands projected for 2013 and ultimately 2020 by the Texas Center for Nursing Workforce Studies (TCNWS)
This strategic plan supports growth regionalization and partnerships as the primary framework to operationalize actions needed by Texas to meet this overwhelming challengeWith the critical shortages of nurses and nurse educators schools of nursing must double enrollments or the state risks being left behind Regionalization has many benefits not the least of which is an increased ability to operate efficiently Currently there are almost one hundred schools of nursing across the stateThe only traditional stumbling block to regionalization is the fear of giving up autonomyThe fear of change can be a strong motivator to maintain the status quoTo meet the workforce needs of the state regionalization and support from health consumer and system partners appears to be primary mechanisms which can assure local control while maximizing resources
B Background
Texas began addressing the reemerging nursing shortage in 1999 under the leadership of the Texas Nurses Association ndash joined by the Texas Hospital Association Nursing Education Policy Coalition (no longer in existence) and the Greater Houston PartnershipThese stakeholders developed a legislative agenda which resulted in the passage of the Nursing Shortage Reduction Act (NSRA) of 2001 (77th Texas Legislature) During the 2003 Texas Legislative Session (78th) the Texas Center for Nursing Workforce Studies was established Each subsequent year the legislature has continued to fund and expand the NSRA resulting in significant investment by the state in addressing the nursing shortage Multiple reports have been produced in response to legislative requests including the 79th and 80th Texas Legislatures
This plan was developed by the Texas Team in coordination with the Office
2
of the Governor for the State of Texas and in response to a call to action by the Center to Champion Nursing in America ndash a joint initiative of AARP the Robert Wood Johnson Foundation US Health Resources and Services Administration (HRSA) and the US Department of LaborThe Texas Team was selected to join 16 other states at a national Nursing Education Capacity Summit (June 2008) hosted by the Center to Champion Nursing in AmericaThe Texas Team eagerly worked to develop a strategic plan which designs new approaches to increase nursing education capacity in the State of Texas Coordination and collaboration among all public and private producers of nurses and consumers of nurses will be critical as Texas plans to meet the healthcare needs from 2013 through 2020
The Texas Team held seven meetings in 2008 ndash June through December ndash to discuss nursing workforce issues nursing education capacity issues and to specifically identify strategies which address the ldquobottle neckrdquo occurring in nursing educationThe Texas Teamrsquos work was augmented by the work of Texas Center for Nursing Workforce Studies the Texas Higher Education Coordinating Board Advisory Committee on RN Nursing Education (ACORN) the Texas Nurses Association the Texas Hospital Association and the Texas Board of Nursing Specifically the Texas Team integrated components from reports and work plans generated by all these collaborating partners
C Coordination and Implementation
The strategic plan is designed to provide guidance over the next four years to state and local nursing workforce planners hospitals community colleges universities and schools of nursing by communicating the necessary steps needed to address nursing education capacity challenges facing the state The plan is designed as a living document that will be updated over time as the nursing education and workforce environments change and as the priority actions are addressed and implemented
Under this plan state agencies and partners represented by the Texas Team are responsible for strengthening coordination and collaboration among the nursing workforce partners ndash governmental agencies community colleges universities health sciences centers local and regional workforce entities hospitals health professional associations businesses and other privatepublic foundations and entities ndash to implement the priority actions and achieve the goals set forth in the planThe Texas Team and endorsing organizations will also serve as the forum for discussion and as the decision making body for changes to the strategic plan
Under the plan all nursing education capacity planning and development activities will be tracked and performance measured to guarantee progress is achieved Nursing workforce funding streams ndash federal state local and private ndash will be identified coordinated and linked to the strategic plan to ensure maximum return on investment
Nursing education capacity is a broad
term which describes the national need to
educate and graduate a professional nursing
workforce to sufficiently meet the nationrsquos future
need for nurses
H
3
0 5000 10000 15000 20000 25000
9700
15199
18000
25000
2010
2013
2015
2020
GRaduaTes Needed foR supply To MeeT deMaNd
D Endorsing Organizations and Plan Availability
Stakeholders provided input into the development of this plan during fall 2008Those organizations and stakeholders that have endorsed this plan agree with the content and agree to support and promote initiatives within their own organizations to implement the planThe plan is a living document and can be accessed along with updated materials and a list of stakeholders at httpwwwdshsstatetxuschscnwsdefaultshtm The Texas Team wishes to thank all those stakeholders who have engaged in development support and implementation of the plan
E Key Findings and Recommendations
bull Texas and the nation are facing a critical shortage of registered nurses (RN)According to a recent report by the TCNWSTexas will not produce sufficient RNs to meet the healthcare demands of Texans through 2020 without major interventions to increase RN supply
bull Between 2005 and 2020 demand for RNs is expected to increase by 86 and supply by only 53
bull Texas schools of nursing turned away 41 (7765) of qualified applicants to nursing schools in 2007 In 2007 85 initial RN licensure nursing programs reported a need for 265 additional full-time and 159 part-time faculty and 93 clinical assistants to increase enrollments by 20
bull Texas schools (86 initial licensure programs) produced 7031 RN graduates in 2007 For supply to meet demand the number of new graduates must grow to 9700 in 2010 15199 by 2013 18000 in 2015 and to 25000 in 2020
bull Although Texas has already implemented multiple strategies via a variety of partnerships and legislative initiatives to meet demand by 2020 additional support is necessary to achieve these goals
bull Increasing capacity in nursing programs will involve bull Acquiring the financial resources to recruit and retain additional qualified faculty and students bull Acquiring additional clinical instruction sites bull Fostering innovative public-private partnerships bull Developing other educational modalities (eg simulation centers)
bull Texas schools of nursing are not all equalThey differ in size in ability to expand capacity in graduation and retention rates in efficiencies in producing graduates and in availability of resources Consequently a single across-the-board approach to increasing RN graduates is not likely to work
4
bull With a critical shortage of nurse educators schools of nursing must change or the state risks being left behindThe state must educate recruit and retain a sufficient nursing faculty workforce New educational modalities and regional sharing of resources are required to assist in addressing the faculty shortage
bull Regionalization appears to be a primary mechanism which can assure expanded capacity while maintaining local control and maximizing limited resources
bull Not all schools will be able to or will want to increase production of initial RN graduates However all schools must be incentivized to produce the maximum number of nursing graduates possible and to support regional efforts to meet the goal of doubling the number of initial RN graduates by 2013
bull A strong need exists for alignment of the Statersquos resources around a shared vision and plan
bull Engaging a broader base of stakeholders is necessary to create new partnerships and successes
bull Texas businesses including hospitals and health plans have a vested interest in assuring healthy Texans and can play a significant role in solving this state wide nursing shortage It behooves Texas businesses to take a proactive approach to mitigate these costs wherever possibleTexas businesses must engage as partners in solving the nursing shortage
bull Education health care sectors private sectors (including businesses) policy and regulation must be linked together to address the shortage of nurses in a synergistic effort to increase the capacity of nursing schools across the state
F Goals and Objectives
This strategic plan communicates high-level goals and strategic objectives while priority actions are presented in a more detailed action plan
Three goals serve as the foundation for the strategic plan
Goal 1 Support Growth and Accountability
By 2013 double the number of graduates from
5
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Texas must strive for synergies partnerships
disruptions and innovation in order to meet the goal of producing sufficient initial RN licensure graduates
H
A Summary
The nation and Texas face a shortage of nurses predicted to worsen over the next twenty years as baby boomers age and the need for health care growsTexas schools of nursing like others across the nation face significant barriers to increasing capacity and output of graduates Nursing schools face the challenge of revising curricula and educational approaches to better match the realities of clinical practice in the 21st century including the need to continuously improve the quality and safety of nursing and health care delivery across the state
The purpose of this Strategic Plan to Address Nursing Education Capacity in Texas is to provide comprehensive strategies which address the complexity of nursing education capacity for the State of Texas and the need to increase the number of graduates to meet demands projected for 2013 and ultimately 2020 by the Texas Center for Nursing Workforce Studies (TCNWS)
This strategic plan supports growth regionalization and partnerships as the primary framework to operationalize actions needed by Texas to meet this overwhelming challengeWith the critical shortages of nurses and nurse educators schools of nursing must double enrollments or the state risks being left behind Regionalization has many benefits not the least of which is an increased ability to operate efficiently Currently there are almost one hundred schools of nursing across the stateThe only traditional stumbling block to regionalization is the fear of giving up autonomyThe fear of change can be a strong motivator to maintain the status quoTo meet the workforce needs of the state regionalization and support from health consumer and system partners appears to be primary mechanisms which can assure local control while maximizing resources
B Background
Texas began addressing the reemerging nursing shortage in 1999 under the leadership of the Texas Nurses Association ndash joined by the Texas Hospital Association Nursing Education Policy Coalition (no longer in existence) and the Greater Houston PartnershipThese stakeholders developed a legislative agenda which resulted in the passage of the Nursing Shortage Reduction Act (NSRA) of 2001 (77th Texas Legislature) During the 2003 Texas Legislative Session (78th) the Texas Center for Nursing Workforce Studies was established Each subsequent year the legislature has continued to fund and expand the NSRA resulting in significant investment by the state in addressing the nursing shortage Multiple reports have been produced in response to legislative requests including the 79th and 80th Texas Legislatures
This plan was developed by the Texas Team in coordination with the Office
2
of the Governor for the State of Texas and in response to a call to action by the Center to Champion Nursing in America ndash a joint initiative of AARP the Robert Wood Johnson Foundation US Health Resources and Services Administration (HRSA) and the US Department of LaborThe Texas Team was selected to join 16 other states at a national Nursing Education Capacity Summit (June 2008) hosted by the Center to Champion Nursing in AmericaThe Texas Team eagerly worked to develop a strategic plan which designs new approaches to increase nursing education capacity in the State of Texas Coordination and collaboration among all public and private producers of nurses and consumers of nurses will be critical as Texas plans to meet the healthcare needs from 2013 through 2020
The Texas Team held seven meetings in 2008 ndash June through December ndash to discuss nursing workforce issues nursing education capacity issues and to specifically identify strategies which address the ldquobottle neckrdquo occurring in nursing educationThe Texas Teamrsquos work was augmented by the work of Texas Center for Nursing Workforce Studies the Texas Higher Education Coordinating Board Advisory Committee on RN Nursing Education (ACORN) the Texas Nurses Association the Texas Hospital Association and the Texas Board of Nursing Specifically the Texas Team integrated components from reports and work plans generated by all these collaborating partners
C Coordination and Implementation
The strategic plan is designed to provide guidance over the next four years to state and local nursing workforce planners hospitals community colleges universities and schools of nursing by communicating the necessary steps needed to address nursing education capacity challenges facing the state The plan is designed as a living document that will be updated over time as the nursing education and workforce environments change and as the priority actions are addressed and implemented
Under this plan state agencies and partners represented by the Texas Team are responsible for strengthening coordination and collaboration among the nursing workforce partners ndash governmental agencies community colleges universities health sciences centers local and regional workforce entities hospitals health professional associations businesses and other privatepublic foundations and entities ndash to implement the priority actions and achieve the goals set forth in the planThe Texas Team and endorsing organizations will also serve as the forum for discussion and as the decision making body for changes to the strategic plan
Under the plan all nursing education capacity planning and development activities will be tracked and performance measured to guarantee progress is achieved Nursing workforce funding streams ndash federal state local and private ndash will be identified coordinated and linked to the strategic plan to ensure maximum return on investment
Nursing education capacity is a broad
term which describes the national need to
educate and graduate a professional nursing
workforce to sufficiently meet the nationrsquos future
need for nurses
H
3
0 5000 10000 15000 20000 25000
9700
15199
18000
25000
2010
2013
2015
2020
GRaduaTes Needed foR supply To MeeT deMaNd
D Endorsing Organizations and Plan Availability
Stakeholders provided input into the development of this plan during fall 2008Those organizations and stakeholders that have endorsed this plan agree with the content and agree to support and promote initiatives within their own organizations to implement the planThe plan is a living document and can be accessed along with updated materials and a list of stakeholders at httpwwwdshsstatetxuschscnwsdefaultshtm The Texas Team wishes to thank all those stakeholders who have engaged in development support and implementation of the plan
E Key Findings and Recommendations
bull Texas and the nation are facing a critical shortage of registered nurses (RN)According to a recent report by the TCNWSTexas will not produce sufficient RNs to meet the healthcare demands of Texans through 2020 without major interventions to increase RN supply
bull Between 2005 and 2020 demand for RNs is expected to increase by 86 and supply by only 53
bull Texas schools of nursing turned away 41 (7765) of qualified applicants to nursing schools in 2007 In 2007 85 initial RN licensure nursing programs reported a need for 265 additional full-time and 159 part-time faculty and 93 clinical assistants to increase enrollments by 20
bull Texas schools (86 initial licensure programs) produced 7031 RN graduates in 2007 For supply to meet demand the number of new graduates must grow to 9700 in 2010 15199 by 2013 18000 in 2015 and to 25000 in 2020
bull Although Texas has already implemented multiple strategies via a variety of partnerships and legislative initiatives to meet demand by 2020 additional support is necessary to achieve these goals
bull Increasing capacity in nursing programs will involve bull Acquiring the financial resources to recruit and retain additional qualified faculty and students bull Acquiring additional clinical instruction sites bull Fostering innovative public-private partnerships bull Developing other educational modalities (eg simulation centers)
bull Texas schools of nursing are not all equalThey differ in size in ability to expand capacity in graduation and retention rates in efficiencies in producing graduates and in availability of resources Consequently a single across-the-board approach to increasing RN graduates is not likely to work
4
bull With a critical shortage of nurse educators schools of nursing must change or the state risks being left behindThe state must educate recruit and retain a sufficient nursing faculty workforce New educational modalities and regional sharing of resources are required to assist in addressing the faculty shortage
bull Regionalization appears to be a primary mechanism which can assure expanded capacity while maintaining local control and maximizing limited resources
bull Not all schools will be able to or will want to increase production of initial RN graduates However all schools must be incentivized to produce the maximum number of nursing graduates possible and to support regional efforts to meet the goal of doubling the number of initial RN graduates by 2013
bull A strong need exists for alignment of the Statersquos resources around a shared vision and plan
bull Engaging a broader base of stakeholders is necessary to create new partnerships and successes
bull Texas businesses including hospitals and health plans have a vested interest in assuring healthy Texans and can play a significant role in solving this state wide nursing shortage It behooves Texas businesses to take a proactive approach to mitigate these costs wherever possibleTexas businesses must engage as partners in solving the nursing shortage
bull Education health care sectors private sectors (including businesses) policy and regulation must be linked together to address the shortage of nurses in a synergistic effort to increase the capacity of nursing schools across the state
F Goals and Objectives
This strategic plan communicates high-level goals and strategic objectives while priority actions are presented in a more detailed action plan
Three goals serve as the foundation for the strategic plan
Goal 1 Support Growth and Accountability
By 2013 double the number of graduates from
5
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
of the Governor for the State of Texas and in response to a call to action by the Center to Champion Nursing in America ndash a joint initiative of AARP the Robert Wood Johnson Foundation US Health Resources and Services Administration (HRSA) and the US Department of LaborThe Texas Team was selected to join 16 other states at a national Nursing Education Capacity Summit (June 2008) hosted by the Center to Champion Nursing in AmericaThe Texas Team eagerly worked to develop a strategic plan which designs new approaches to increase nursing education capacity in the State of Texas Coordination and collaboration among all public and private producers of nurses and consumers of nurses will be critical as Texas plans to meet the healthcare needs from 2013 through 2020
The Texas Team held seven meetings in 2008 ndash June through December ndash to discuss nursing workforce issues nursing education capacity issues and to specifically identify strategies which address the ldquobottle neckrdquo occurring in nursing educationThe Texas Teamrsquos work was augmented by the work of Texas Center for Nursing Workforce Studies the Texas Higher Education Coordinating Board Advisory Committee on RN Nursing Education (ACORN) the Texas Nurses Association the Texas Hospital Association and the Texas Board of Nursing Specifically the Texas Team integrated components from reports and work plans generated by all these collaborating partners
C Coordination and Implementation
The strategic plan is designed to provide guidance over the next four years to state and local nursing workforce planners hospitals community colleges universities and schools of nursing by communicating the necessary steps needed to address nursing education capacity challenges facing the state The plan is designed as a living document that will be updated over time as the nursing education and workforce environments change and as the priority actions are addressed and implemented
Under this plan state agencies and partners represented by the Texas Team are responsible for strengthening coordination and collaboration among the nursing workforce partners ndash governmental agencies community colleges universities health sciences centers local and regional workforce entities hospitals health professional associations businesses and other privatepublic foundations and entities ndash to implement the priority actions and achieve the goals set forth in the planThe Texas Team and endorsing organizations will also serve as the forum for discussion and as the decision making body for changes to the strategic plan
Under the plan all nursing education capacity planning and development activities will be tracked and performance measured to guarantee progress is achieved Nursing workforce funding streams ndash federal state local and private ndash will be identified coordinated and linked to the strategic plan to ensure maximum return on investment
Nursing education capacity is a broad
term which describes the national need to
educate and graduate a professional nursing
workforce to sufficiently meet the nationrsquos future
need for nurses
H
3
0 5000 10000 15000 20000 25000
9700
15199
18000
25000
2010
2013
2015
2020
GRaduaTes Needed foR supply To MeeT deMaNd
D Endorsing Organizations and Plan Availability
Stakeholders provided input into the development of this plan during fall 2008Those organizations and stakeholders that have endorsed this plan agree with the content and agree to support and promote initiatives within their own organizations to implement the planThe plan is a living document and can be accessed along with updated materials and a list of stakeholders at httpwwwdshsstatetxuschscnwsdefaultshtm The Texas Team wishes to thank all those stakeholders who have engaged in development support and implementation of the plan
E Key Findings and Recommendations
bull Texas and the nation are facing a critical shortage of registered nurses (RN)According to a recent report by the TCNWSTexas will not produce sufficient RNs to meet the healthcare demands of Texans through 2020 without major interventions to increase RN supply
bull Between 2005 and 2020 demand for RNs is expected to increase by 86 and supply by only 53
bull Texas schools of nursing turned away 41 (7765) of qualified applicants to nursing schools in 2007 In 2007 85 initial RN licensure nursing programs reported a need for 265 additional full-time and 159 part-time faculty and 93 clinical assistants to increase enrollments by 20
bull Texas schools (86 initial licensure programs) produced 7031 RN graduates in 2007 For supply to meet demand the number of new graduates must grow to 9700 in 2010 15199 by 2013 18000 in 2015 and to 25000 in 2020
bull Although Texas has already implemented multiple strategies via a variety of partnerships and legislative initiatives to meet demand by 2020 additional support is necessary to achieve these goals
bull Increasing capacity in nursing programs will involve bull Acquiring the financial resources to recruit and retain additional qualified faculty and students bull Acquiring additional clinical instruction sites bull Fostering innovative public-private partnerships bull Developing other educational modalities (eg simulation centers)
bull Texas schools of nursing are not all equalThey differ in size in ability to expand capacity in graduation and retention rates in efficiencies in producing graduates and in availability of resources Consequently a single across-the-board approach to increasing RN graduates is not likely to work
4
bull With a critical shortage of nurse educators schools of nursing must change or the state risks being left behindThe state must educate recruit and retain a sufficient nursing faculty workforce New educational modalities and regional sharing of resources are required to assist in addressing the faculty shortage
bull Regionalization appears to be a primary mechanism which can assure expanded capacity while maintaining local control and maximizing limited resources
bull Not all schools will be able to or will want to increase production of initial RN graduates However all schools must be incentivized to produce the maximum number of nursing graduates possible and to support regional efforts to meet the goal of doubling the number of initial RN graduates by 2013
bull A strong need exists for alignment of the Statersquos resources around a shared vision and plan
bull Engaging a broader base of stakeholders is necessary to create new partnerships and successes
bull Texas businesses including hospitals and health plans have a vested interest in assuring healthy Texans and can play a significant role in solving this state wide nursing shortage It behooves Texas businesses to take a proactive approach to mitigate these costs wherever possibleTexas businesses must engage as partners in solving the nursing shortage
bull Education health care sectors private sectors (including businesses) policy and regulation must be linked together to address the shortage of nurses in a synergistic effort to increase the capacity of nursing schools across the state
F Goals and Objectives
This strategic plan communicates high-level goals and strategic objectives while priority actions are presented in a more detailed action plan
Three goals serve as the foundation for the strategic plan
Goal 1 Support Growth and Accountability
By 2013 double the number of graduates from
5
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
0 5000 10000 15000 20000 25000
9700
15199
18000
25000
2010
2013
2015
2020
GRaduaTes Needed foR supply To MeeT deMaNd
D Endorsing Organizations and Plan Availability
Stakeholders provided input into the development of this plan during fall 2008Those organizations and stakeholders that have endorsed this plan agree with the content and agree to support and promote initiatives within their own organizations to implement the planThe plan is a living document and can be accessed along with updated materials and a list of stakeholders at httpwwwdshsstatetxuschscnwsdefaultshtm The Texas Team wishes to thank all those stakeholders who have engaged in development support and implementation of the plan
E Key Findings and Recommendations
bull Texas and the nation are facing a critical shortage of registered nurses (RN)According to a recent report by the TCNWSTexas will not produce sufficient RNs to meet the healthcare demands of Texans through 2020 without major interventions to increase RN supply
bull Between 2005 and 2020 demand for RNs is expected to increase by 86 and supply by only 53
bull Texas schools of nursing turned away 41 (7765) of qualified applicants to nursing schools in 2007 In 2007 85 initial RN licensure nursing programs reported a need for 265 additional full-time and 159 part-time faculty and 93 clinical assistants to increase enrollments by 20
bull Texas schools (86 initial licensure programs) produced 7031 RN graduates in 2007 For supply to meet demand the number of new graduates must grow to 9700 in 2010 15199 by 2013 18000 in 2015 and to 25000 in 2020
bull Although Texas has already implemented multiple strategies via a variety of partnerships and legislative initiatives to meet demand by 2020 additional support is necessary to achieve these goals
bull Increasing capacity in nursing programs will involve bull Acquiring the financial resources to recruit and retain additional qualified faculty and students bull Acquiring additional clinical instruction sites bull Fostering innovative public-private partnerships bull Developing other educational modalities (eg simulation centers)
bull Texas schools of nursing are not all equalThey differ in size in ability to expand capacity in graduation and retention rates in efficiencies in producing graduates and in availability of resources Consequently a single across-the-board approach to increasing RN graduates is not likely to work
4
bull With a critical shortage of nurse educators schools of nursing must change or the state risks being left behindThe state must educate recruit and retain a sufficient nursing faculty workforce New educational modalities and regional sharing of resources are required to assist in addressing the faculty shortage
bull Regionalization appears to be a primary mechanism which can assure expanded capacity while maintaining local control and maximizing limited resources
bull Not all schools will be able to or will want to increase production of initial RN graduates However all schools must be incentivized to produce the maximum number of nursing graduates possible and to support regional efforts to meet the goal of doubling the number of initial RN graduates by 2013
bull A strong need exists for alignment of the Statersquos resources around a shared vision and plan
bull Engaging a broader base of stakeholders is necessary to create new partnerships and successes
bull Texas businesses including hospitals and health plans have a vested interest in assuring healthy Texans and can play a significant role in solving this state wide nursing shortage It behooves Texas businesses to take a proactive approach to mitigate these costs wherever possibleTexas businesses must engage as partners in solving the nursing shortage
bull Education health care sectors private sectors (including businesses) policy and regulation must be linked together to address the shortage of nurses in a synergistic effort to increase the capacity of nursing schools across the state
F Goals and Objectives
This strategic plan communicates high-level goals and strategic objectives while priority actions are presented in a more detailed action plan
Three goals serve as the foundation for the strategic plan
Goal 1 Support Growth and Accountability
By 2013 double the number of graduates from
5
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
bull With a critical shortage of nurse educators schools of nursing must change or the state risks being left behindThe state must educate recruit and retain a sufficient nursing faculty workforce New educational modalities and regional sharing of resources are required to assist in addressing the faculty shortage
bull Regionalization appears to be a primary mechanism which can assure expanded capacity while maintaining local control and maximizing limited resources
bull Not all schools will be able to or will want to increase production of initial RN graduates However all schools must be incentivized to produce the maximum number of nursing graduates possible and to support regional efforts to meet the goal of doubling the number of initial RN graduates by 2013
bull A strong need exists for alignment of the Statersquos resources around a shared vision and plan
bull Engaging a broader base of stakeholders is necessary to create new partnerships and successes
bull Texas businesses including hospitals and health plans have a vested interest in assuring healthy Texans and can play a significant role in solving this state wide nursing shortage It behooves Texas businesses to take a proactive approach to mitigate these costs wherever possibleTexas businesses must engage as partners in solving the nursing shortage
bull Education health care sectors private sectors (including businesses) policy and regulation must be linked together to address the shortage of nurses in a synergistic effort to increase the capacity of nursing schools across the state
F Goals and Objectives
This strategic plan communicates high-level goals and strategic objectives while priority actions are presented in a more detailed action plan
Three goals serve as the foundation for the strategic plan
Goal 1 Support Growth and Accountability
By 2013 double the number of graduates from
5
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Texas Nursing Schools to 15199
Strategy 11 Support the strategies recommended by the Texas Nursing Workforce Shortage Coalition to seek funding in the 81st Texas Legislature which supports doubling initial RN licensure graduates by 2013
Support Growth and Accountability By 2013 double the number of initial RN graduates from Texas Schools of Nursing to 15199
Develop Regional Academic Partnerships Create new efficiencies and innovations in nursing education through development of regional partnerships which support doubling the number of initial RN graduates
Leverage New Partnerships Establish new relationships and partnerships with health care consumers system participants (eg hospitals health plans and business communities) and academic institutions to support development of the nursing workforce
6
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
PRImARy LEAD Texas Nursing Workforce Shortage Coalition (A joint effort of Arlington Chamber of Commerce Brazos Valley Chamber of Commerce Dallas-Fort Worth Hospital Council Deans amp Directors of Texas Schools of Nursing Greater Houston Partnership Greater San Antonio Hospital CouncilTeaching Hospitals of TexasTexas Association of BusinessTexas Hospital AssociationTexas Nurses Association and Texas Organization of Rural amp Community Hospitals)
The Nursing Workforce Shortage Coalition represents a broad based group of stakeholders representing business education and consumers of healthcareThe coalition agrees that the best way to approach the goal of doubling the number of initial RN licensure graduates by 2013 is via expansion of the Nursing Shortage Reduction Program (initially passed by the legislature in 2001)
Phase I of the Nursing Shortage Reduction Program included $147 million per biennium Even with this level of funding it is estimated that by 2013 production will lag behind demand by approximately 5000 RNs per year The initial $147 million has produced a cumulative 55 percent growth in nursing graduates However the Coalition believes that further investment of state funds into the Nursing Shortage Reduction Program is necessary to reach the goal of 15199 initial RN graduates in 2013 in order to meet the needs of Texas citizens
Coalition members support strategies created by regional coalitions of nursing schools and community partners while being accountable for producing more nursing graduatesAll funding supporting such strategies should be based on a business plan and provide evidence of outcomes related to goal achievementAccountability for those receiving additional state andor private funding must be linked to productivity outcomes (ie production of graduates)
7
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Strategy 12 Establish targets and measure progress on producing graduates utilizing ldquobusiness modelrdquo concept
PRImARy LEAD TCNWS amp Texas Higher Education Coordinating Board (THECB)
To meet growth projectionsTexas must establish target numbers for graduates and monitor progress toward meeting those targets to assure that the state has sufficient resources to meet the nursing health care needs of 2013 and beyond All schools of nursing in the state must respond to the need for growth and set strategic goals to reach the overall number of graduates needed to meet workforce demandsThis plan supports the concept of regionalization and recommends that the state be divided into regions and that each region of the state be given a target goal or ldquofair sharerdquo of the total number of graduates needing to be produced by Texas schools of nursing Each region would then utilize strategies identified within this plan andor potential other strategies not identified in order to achieve the established target number of RN graduates by 2013
Strategy 13 Calculate graduation rates and promote best practices
PRImARy LEAD THECB and Texas Board of Nursing (TBON)
Ensuring the graduation of nursing graduates from Texas Schools of Nursing is a critical strategy toward goal achievement of doubling the number of graduatesThe TCNWS 2007 Update on Professional Nursing Programs reported additional resources were needed to retain students Graduation rates will be calculated for all schools in the state and best practices will be promoted across schools by the THECB and BON Examples of best practices include ACE (Achieving College Excellence) which provides academic support through tutorial services peer advising and workshops to enhance academic performance and student development (ie time management stress reduction study skills and test-taking skills) Retention strategies should be coordinated across designated regions assuring that schools with low graduation rates are mentoredsupported by partner regional schools
Goal 2 Develop Regional Academic Partnerships
Create new efficiencies and innovations through development of regional academic partnerships
Strategy 21 Create regional nursing schoolacademic partnerships which support rapid growth of high quality educational programs
8
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
In order to double the number of initial RN graduates by 2013 followed by the needed four-fold increase in graduates by 2020 a strategically coordinated response must be launched which engages all existing and future schools of nursing in the stateTexas currently has 94 schools of nursing along with a growing number of new schools preparing initial licensure graduatesTo increase the supply of nurses to meet healthcare needs of a growing and diverse population presents unique challenges in a large state such as Texas
Regionalization is envisioned as the backbone to success in achieving this goal Regionalization provides opportunities for a unified strategic approach to address the nursing shortage and to overcome nursing education capacity issues in order to meet the states needs By creating regional innovation systems that can drive expansion of nursing schools assets ndash human capital institutional and community ndash can be leveraged to address the critical shortage of nursesA systematic regional process can be utilized to identify innovation assets or develop strategies to ensure that these assets are sufficiently linked and leveraged
The fear of change can be a strong motivator to maintain the status quo But with critical shortages of nurses and nurse educators schools of nursing must change or the state risks being left behindThis strategic plan supports regionalization of Texas Schools of Nursing Regionalization has many benefits not the least of which is an increased ability to operate efficiently As of November 2008 there were 94 schools of nursing across the state To meet the nursing workforce needs of the State regionalization appears to be one primary mechanism by which local control can be assured while maximizing resources and leveraging regional assetsstrengths
Sub-Strategy 211 Support curriculum models for RN nursing education in Texas which promotes regional sharing of resources
PRImARy LEAD THECB
9
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Beyond the challenge of increasing capacity to educate a sufficient number of qualified RN graduatesTexas nursing schools are also challenged to make curriculum revisionsThe 2003 Institute of Medicine ReportldquoHealth Professions A Bridge to Qualityrdquo calls for educational institutions to ensure that their health educational programs help students ldquodevelop and maintain proficiency in five core areas
bull Patient safety coupled with patient-centered care
bull Working as part of interdisciplinary teams
bull Practicing evidence-based nursing
bull Focusing on quality improvement and
bull Using information technology
The Robert Wood Johnson Foundation funded Quality and Safety Education for Nurses (QSEN) to assist programs to integrate these competencies into the undergraduate nursing curricula
This Texas plan supports ldquoA New Curriculum Model for Initial RN Licensure Programsrdquo developed by the THECB in fall 2008 which utilizes the five core competencies identified by the Institute of Medicine (IOM) and QSEN strategies for integration into the nursing curricula Regional application of this or similar models of nursing education curricula would facilitate regional sharing of resources including shared faculty through joint or adjunct appointments and shared expertise in curricular design
Sub-Strategy 212 Create and implement a plan which aligns regional faculty resources and development initiatives
PRImARy LEAD Designated Regional Leaders in Collaboration with Regional Schools and Partners
The nurse faculty shortage presents a significant barrier to increasing a schoolrsquos enrollment capacity Efforts to increase the number of Texas faculty have focused on expansion of mastersdoctoral education programs and targeting clinical practice nurses for faculty extensionclinical education support rolesThis plan further endorses collaboration among community colleges universities and health sciences centers to leverage scarce faculty resources Schools of nursing hospital partners and other health care entities located in identified regions of the state should work together to ldquoshare facultyrdquo among regional schoolshospitalsentities collaboratively designing and implementing a plan to ldquogrow their ownrdquo and initiate developmental activities which leverage a regional approach
Regional partners should also support students and graduates to progress up the nursing career ladder ndash from high school to certified nursing assistant to licensed vocation nurse to registered nurse to baccalaureate preparation and on to the highest levels of education ndash including supporting those who
10
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
seek to become nurse educators Each region should assess mechanisms to assure sufficient numbers of nursing faculty and create methodologies strategies to develop a robust faculty pipeline needed to double initial RN licensure graduates by 2013
Sub-Strategy 213 Create regional interdisciplinary clinical simulation centers which expand clinical education capacity and support new models of clinical education
PRImARy LEAD THECB
The utilization of clinical simulation centers as a venue for clinical education in the health professions is growingThe aviation industry was on the forefront of creating ldquosimulated environmentsrdquo with the advent of ldquoflight simulatorsrdquo in training pilots to fly before venturing into the sky with hundreds of customers Historically health professionals have learned to ldquoflyrdquo in real health care settings (ie hospitals clinics operating rooms) with real patients New evidence based educational outcomes are emerging which validate the value of clinical simulation as a safe and highly effective strategy in the education of nurses and other health care providersThese centers provide health professions students an opportunity to learn in a simulated environment before delivering care to actual patients Simulation is used to improve clinical decision making psychomotor skills communication techniques and improve teamwork Students are able to make mistakes and learn from those mistakes without risks to patients allowing the learner to review and practice procedures as often as required to obtain proficiency without harm to patients Some believe that in the future at least 50 of all nursing clinical education can be provided in clinical simulation centers while conserving already overcrowded and congested clinical sites for expanding numbers of students
Clinical simulation centers are designed to replicate a clinical setting Cost of building simulation centers vary according to design equipment and volume of planned usageA regional approach should be utilized to share this type of valuable resource in order to reduce cost and maximize production of initial RN graduates across the state Regionalization of clinical simulation resources can be realized through academic and community coordination regional arrangements to share faculty and technical resources collaborative and innovative models of education and the commitment of partnerships that can bring creative funding which promotes excellence in nursing education patient safety and interdisciplinary teamwork
Sub-Strategy 214 Develop regional clinical placement of students to maximize competency attainment and faculty resource sustainability
PRImARy LEAD Regional Partners with support from THECB and TBON
As a practice oriented profession nurses learn to provide care in actual care
This strategic plan supports growth regionalization
and partnerships as the primary framework to operationalize actions
needed by Texas to meet this
overwhelming challenge
H
11
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
delivery settings ndash hospitals clinics community centers etc (clinical affiliates) ndash under the supervision of facultyTexas schools of nursing consistently report insufficient space in clinical affiliates as a barrier to expanding enrollments and graduationsTo meet the goal of doubling graduates by 2013 an efficient method of managing clinical placement is essential to increase the capacity for enrollments Some areas of the state utilize computerizedstandardized clinical placement tools and methodologies Regions should develop systems which maximize collaboration and increase clinical placement availability including clinical placement in regional clinical simulation centers
Sub-Strategy 215 Develop regional portalpathway education systems to increase nursing school admissions promote retention activities and seamless transition between associate and baccalaureate education
PRImARy LEAD Regional Partners with support from THECB and TBON
Lack of standardized application systems result in duplication of applications vacant admission slots and the inability to utilize resources to assess track and retain ldquoat risk studentsrdquoTexas is currently funding two pilots through the 2008-2009 Nursing Innovation Grant Program to address both a common application portal and a robust retention portal Strategies being tested include a standardized student application portal centralized student database which addresses student background academic and environmental variables protocols for identifying at-risk students at point of entry into nursing school standardized intervention protocols and collection of data to assess effectiveness of intervention strategies employed to retain students These two pilots should be considered ldquoalphardquo testing and lessons learned should be applied on a larger statewide regional ldquobeta testingrdquo in other areas of the state
Goal 3 Leverage New Partnerships
Establish new relationships and partnerships between and among health care system participants (eg hospitals health plans and business) and academic institutions to support development of nursing workforce
Strategy 31 Support New Producers
PRImARy LEAD TBON
12
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Texas currently has 94 schools of nursing preparing initial RN licensure graduates Recent state and national trends indicate a proliferation of schools of nursing across the countryThe challenge of doubling the production of initial RN licensure graduates by 2013 is daunting and even more so to obtain a four-fold increase by 2020Texas should support new producersThe TBON ndash who first learns of intent for new producers to start new programs ndash should identify mechanisms to assure integration and support for new producers into the various regions of the state Partner clinical affiliate agencies should strategically assure that current and planned clinical placement of nursing students be managed to maximize production of initial RN licensure graduates while assuring delivery of safe nursing care to patients Regional leaders should seek integration of new producers into existing systems of education and care delivery utilizing strategies which leverage regional resources ndash including faculty clinical simulation centers and clinical space
Strategy 32 Develop and expand partnerships between nursing programs and their clinical and community affiliates
PRImARy LEAD Texas Hospital Association (THA)
The state and nursing must have the support of hospitals and other consumers of nurses to reach the goal of doubling the number of initial RN graduates by 2013 Many hospitals and clinicalcommunity affiliates have a long history of supporting nursing education however all must seriously consider stretching to maximize support of nursing schools in their regions and when possible around the state Examples of support mechanisms include traditional methodologies such as provision of scholarship support for students and provision of clinical faculty All hospitals clinical and community affiliates must consider leveraging of practicing nurses to serve as clinical faculty provision of incentives to nursing faculty ndash such as endowed chairs and professorships development of practice-scholar roles provision of scholarshipstuition support for students enrolled in graduate nursing education programs creation of designated clinical units
13
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
support for clinical simulation centers and other innovations
Strategy 33 Utilize Asset Mapping to leverage regional publicprivate partnerships to strengthen educational infrastructure
PRImARy LEAD Regional partners with support of AARP Center to Champion NursingTexas Nurses Foundation
Asset mapping is a tool designed to support development by cataloguing resources identifying needs and strengthening or forming new partnerships toward common goalsAsset mapping supports the sharing of knowledge about isolated or underutilized resourcesThose resources could be leveraged toward the goal of doubling nursing graduates As leaders see common interests and organizational links they may be inspired to strengthen or form new partnerships to build upon the systemrsquos assets Asset mapping should be promoted at a regional level to encourage the realignment of existing efforts in educational workforce and economic development programs to meet the challenge of doubling initial RN graduates by 2013 Each region will need to ascertain the necessary resources to meet this goal
Strategy 34 Seek support from Texas US Congressional delegation to secure additional federal funding for nursing workforce projects in Texas and identify federal policies and regulations which serve as roadblocks to capacity expansion
PRImARy LEAD Honorable Representative Donna Howard in collaboration with the Texas Office of State-Federal Relations
Texas should provide leadership in educating the Texas US Congressional delegation on the critical impact and economic implications of failing to meet the nursing workforce demands from 2013 through 2020 Leadership is needed that describes policy and regulatory requirements that both facilitate and create barriers to expanding nursing education capacity describe options for innovation that would further enable capacity expansion and identify federal funding streams to support capacity expansion
G Strategic Action Plan
Appendix A contains a detailed strategic action plan with identified activities and methods of delivery responsible entities proposed timelines for achievement and anticipated outcomesAs previously notedldquoA Strategic Plan for the State of Texas to Meet Nursing Workforce Needs of 2013rdquo is a living document that will be updated and continually evolve over time as the nursing workforce and education environments change and as the priority actions are addressed and fully implemented
14
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
H Reference Documents amp Resources
Allen P Schumann R Collins C amp Selz N (2007) Reinventing practice and education partnerships for capacity expansion Journal of Nursing Education 46(4) 170-175
Association of Academic Health Centers (2008) Out of order out of time The state of the nationrsquos health workforceWashington DCAAHC
Boller J amp Jones D (2008) Nursing education redesign for CaliforniaWhite paper and strategic action plan recommendations Berkley CA California Institute for Nursing and Health Care wwwcinhcorg or infocinhcorg
BrownT (2008) Design thinking Harvard Business Review 86(6) 84-92
Council on Competitiveness (2005) Illuminate - Asset mapping roadmap A guide to assessing regional development resourcesWashington DC US Dept of Labor
DallTYaozhu C Seifer R Maddox P amp Hogan P (2009) The economic value of professional nursing Medical Care 47 (1) 97-104
Green A amp Kishi A (2008) Blowing open the bottleneck A firsthand account of the national nursing education capacity summit NurseWeek Aug
GreenA Fowler C Sportsman S Cottenoir M Light K and Schumann R (2006) Innovation in nursing education A state-wide grant initiative Policy Politics amp Nursing Practice 7(1) 1-9
GreenAWieck KLWillmann J Fowler C DouglasW and Jordan C (2004)Addressing theTexas nursing shortageA legislative approach to bolstering the nursing education pipeline Policy Politics amp Nursing Practice 5(1) 41-48
Health Industry Steering Committee (2008) Clinical rotation system Capital Area Workforce Board Available on-line wwwctxplacementorg
Jackson E (2008) State innovations to combat the nursing shortageA paper prepared for the Texas Nursing Education Capacity TeamAustin TexasAuthor
Joynt J amp Kimball B (2008) Blowing open the bottleneck Designing new approaches to increase nurse education capacityA white paper presented at the Center to Champion Nursing in America National Nursing Education Summit 2008ArlingtonVA UCSF Center for Health Professions
Kishi A amp Green A (2008) A statewide strategy for nursing workforce development through partnerships in Texas Policy Politics amp Nursing Practice 9(3) 210 ndash 214
KuhnThomas S (1970)The structure of scientific revolutions Second Ed EnlargedThe University of Chicago Press Chicago
15
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Massachusetts Board of Higher Education amp Massachusetts Organization of Nurse Executives (2006) Creativity amp connections Building the framework for the future of nursing education amp practiceWorchester MAAuthor Available at wwwmassoneorg or wwwmassedu
OCNE (2007) Update on progress ndash final edition Oregon Consortium for Nursing Education Available on-line wwwocneorg
Pennsylvania Center for Health Careers (2006) Increasing Pennsylvaniarsquos clinical education capacity Recommendation report from the clinical education taskforce Harrisburg PA Pennsylvania Workforce Investment Board Available on-line wwwpaworkforcestatepaus
Schramm J (2006)The SHRM 2006 symposium on health care costs and the future of US competitiveness AlexandriaVA Society for Human Resource Management
Starck P Love K amp McPherson R (2008) Calculating graduation rates Journal of Professional Nursing (24)4 197-204
State Health Coordinating Council (2008) How can Texas maximize the use of regional interdisciplinary simulation centers in the initial and continuing education of Texas health professionals while supporting innovative educational research and promoting excellence in health professions education patient safety and training assessment A white paper prepared for SHCC AustinTexas Author
Texas Higher Education Coordinating Board (2008) A new curriculum model for initial RN licensure programsAustinTXAuthorAvailable at httpwwwthecbstatetxus
Texas Higher Education Coordinating Board (2008) Overview of current funded innovation grants inTexas AY 20080-AY 2009A summary document prepared for the Texas Nursing Education Capacity TeamAustinTXAuthor
Texas Higher Education Coordinating Board (2006) Strategies to increase the number of graduates from initial RN licensure programsA report to the Texas LegislatureAustinTXAuthor
Texas Center for Nursing Workforce Studies (2008) 2007 update on professional nursing programs Resources needed to increase capacity geographic location and length of curriculum Publication 25-13026 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on faculty demographics in professional nursing programs Publication 25-13027 Austin TX Kishi A Available at httpwwwdshsstatetxuschscnwsdefault shtm
Texas Center for Nursing Workforce Studies (2008) 2007 update on student admission enrollment and graduation trends in professional nursing
16
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
programs Publication 25-13025 AustinTX Kishi A Available at http wwwdshsstatetxuschscnwsdefaultshtm
Texas Center for Nursing Workforce Studies (2007) Professional nursing education in Texas Demographics amp trends 2006 AustinTX Kishi A Available at httpwwwdshsstatetxuschscnwsdefaultshtm
Texas Health Care Policy Council (2007) Commitment to health workforce planning A strategy for addressing Texasrsquo health workforce needs A policy paper developed by the Texas Health Workforce Planning Subcommittee and the Texas Health Care Policy Council AustinTXAuthorAvailable at httpwwwdshsstatetxuschscnwsdefaultshtm
IAcknowlegements
The Texas Team gratefully acknowledges the contributions and leadership of the Center to Champion Nursing in America the Texas Office of the Governor the Texas Higher Education Coordinating Board the Texas Board of Nursing the Texas Hospital Association the Texas Nurses Association Texas and the Texas Center for Nursing Workforce Studies
TExAS NuRSING EDuCATION CAPACITy TEAm mEmBERS
Alexia Green RN PhD FAAN ndash Team Leader alexiagreenttuhscedu RepresentingTexas Health Care Policy Council amp Health Workforce Planning Partnership Subcommittee
17
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Clair Jordan RN MSN cjordantexasnursesorg RepresentingTexas Nurses Association
Aileen Kishi RN PhD aileenkishidshsstatetxus RepresentingTexas Center for Nursing Workforce Studies
Chris Fowler MPA chrisfowlerthecbstatetxus RepresentingTexas Higher Education Coordinating Board
Kathy Thomas RN MSN kathythomasbonstatetxus RepresentingTexas Board of Nursing
Sondra Flemming RN MS sflemmingdcccdedu Representing Associate Degree Education
Beth Mancini RN PhD FAAN manciniutaedu Representing Baccalaureate Degree Education
Elizabeth Sjoberg RN JD esjobergthaorg RepresentingTexas Hospital Association
Bonnie Gonzalez bonniewfsolutionsorg RepresentingTexas Workforce Systems
Amanda Fredriksen AFredriksenaarporg Representing AARP
The Honorable Donna Howard RN BSN MA Texas House of Representatives RepresentingTexas House Higher Education Committee
Scheleen Walker scheleenwalkerhousestatetxus RepresentingThe Honorable Donna Howard RN BSN MA
ADDITIONAL CONTRIBuTORS
Tony Gilman BA Executive OfficerTexas Health Care Policy Council
18
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19
Office of the Governor State of Texas
Catherine Bingle MPA Texas Workforce Commission
Erin Jackson RN University of Texas at Austin Graduate Student Intern RepresentingThe Honorable Representative Donna Howard
19